News Scan for Jun 24, 2019

News brief

CDC notes 33 more US measles cases, raising total to 1,077

In its latest measles update today, the Centers for Disease Control and Prevention recorded 33 more measles cases in the previous week, raising 2019's total to 1,077 cases—the most cases in the United States since 1992 and since measles was declared eliminated in 2000.

Twenty-eight states have reported cases in 2019, which did not change since last week. The CDC is tracking five ongoing outbreaks (3 or more related cases) in New York's Rockland County; New York City; Butte County, California; Pennsylvania; and Washington state.

As of Jun 17, New York City had noted 596 cases in a measles outbreak that began last September in Brooklyn and Queen's predominantly Orthodox Jewish communities. New York City has mandated vaccination with the measles, mumps, and rubella vaccine, and residents who fail to vaccinate or prove medical exemption may be fined $1,000.

Officials have confirmed 275 measles cases in nearby Rockland County, New York, as of Jun 19. That outbreak also began last September, and like other major outbreaks across the country, has been connected to an unvaccinated foreign traveler.
Jun 24 CDC update

Jun 17 NYC Health update
Jun 19 Rockland County update

 

Saudi Arabia reports new MERS case in Ar Rass

Over the weekend health officials in Saudi Arabia reported another MERS-CoV case in Ar Rass, a city in Al Qassim province in the central part of the country.

The patient is a 42-year-old man with recent camel contact. The Ministry of Health (MOH) classified the patient's illness as primary, meaning he likely didn't contract MERS-CoV (Middle East respiratory syndrome coronavirus) from another patient.

Saudi Arabia has now reported 153 cases for the year.
Jun 22 Saudi MOH epidemiologic week 25 report

 

Large Somalia cholera vaccine campaign targets high-risk districts

To curb a cholera outbreak in Somalia that has been under way since January, the country's health officials and global partners on Jun 22 launched one of Africa's largest oral cholera vaccine campaigns, targeting more than 650,000 people age 1 year and older in high-risk areas, according to a statement from the World Health Organization (WHO).

In 2017, the country experienced one of its largest outbreaks, which sickened more than 78,000 people and resulted in 1,159 deaths. The following year, Somalia cut the number of infections to about 6,500 and reduced the case-fatality rate because of better surveillance and case management, the WHO said. So far this year, 1,041 suspected cases have been reported, 1 of them fatal, from 25 districts in states in the Jubba and Shabelle river basins.

During the campaign's two rounds, vaccinators will go house to house in six districts in South West state and one district in Lower Juba region. Community mobilizers are visiting households in the communities in advance to inform them about the vaccination dates and the benefits of immunization. Besides Somalia's health ministry, groups involved in the campaign include the WHO; UNICEF; Gavi, the Vaccine Alliance; and the Global Task Force for Cholera Control.

The goals of the campaign are to eliminate the risk of cholera in vulnerable populations and prevent Somalia's outbreaks from recurring.

Mamunur Rehman Malik, MBBS, the WHO's representative in Somalia, said in the WHO statement, "No one should die of cholera in the 21st century, especially when we have an affordable and easily administrable cure. It remains our collective responsibility to save lives and end cholera in Somalia. We remain committed to keeping the country free from future cholera outbreaks."
Jun 22 WHO press release

Stewardship / Resistance Scan for Jun 24, 2019

News brief

Compliance with CDC stewardship elements linked to higher antibiotic use

In a surprise finding, an analysis of US hospitals today in Infection Control and Hospital Epidemiology has found that meeting all seven of the Centers for Disease Control and Prevention's (CDC's) core elements of hospital antibiotic stewardship programs is associated with higher use of certain antibiotics than meetings six or fewer elements.

The cross-sectional analysis, led by researchers from Virginia Commonwealth University, used responses from a survey that was sent to antibiotic stewardship program (ASP) members at more than 400 hospitals in April 2016. The surveys contained 24 questions regarding aspects of the ASPs and whether they met the CDC's seven core elements, which include leadership, accountability, drug expertise, tracking, actions, reporting, and education. The responses to the survey were then linked to antibacterial use data, measured in days of therapy (DOT) per 1,000 patient-days (PD).

Overall, 211 of 446 hospitals responded to the survey, and antibiotic use was measured in a subset of 57 hospitals that completed the survey and subscribe to a database that tracks inpatient medication use. Of the 57 hospitals, 27 (47%) met all 7 core elements and 30 (53%) met 3 to 6 elements. The analysis found that compliance with all 7 core elements was associated with higher use of broad-spectrum antibiotics for community-acquired infections (145 DOT/1,000 PD vs 124 DOT/1,000 PD, P = .03) and anti–methicillin-resistant Staphylococcus aureus agents (155 DOT/1,000 PD vs 133 DOT/1,000 PD, P = .02).

The findings were unexpected, as the researchers thought that hospitals that met all the core elements would likely use fewer antibiotics. But they note that it's possible that the hospitals that adopted all elements may have required a more robust ASP because of a higher baseline rate of antibiotic use. In addition, they say that the results may have differed if antibacterial use data had been available for all the hospitals that completed the survey.
Jun 24 Infect Control Hosp Epidemiol study

 

Study: Pediatric dengue patients overprescribed antibiotics in Indonesia

A new study in PLOS Neglected Tropical Diseases suggests children at private hospitals in Indonesia are overprescribed antibiotics when seeking treatment for dengue fever.

Dengue is endemic in Indonesia, and infections with the flavivirus are one of the leading causes of pediatric hospitalization. In this retrospective study, researchers looked at the prevalence of antibiotics prescribed to dengue patients under the age of 15 in teaching and private hospitals in the city of Bandung in 2015.

The authors found that the use of antibiotics in private hospitals was mostly inappropriate. A total of 17.5% out of 3,078 cases in both hospitals received antibiotics. Among cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in only 1 case (0.6%) and 6 cases (3.4%), respectively, the authors said.

Among 2,902 dengue cases in the private hospital, presumed bacterial URTI was found in 324  cases (11.2%), typhoid fever in 188 cases (6.5%), and urinary tract infection in 18 cases (0.6%). In 67% of URTI cases, broad-spectrum third generation antibiotics were prescribed.

"The use of this agent for URTI is considered as misuse of antibiotics, which can result in detrimental effects for the patients, and the healthcare system, including the emergence of antibiotic resistant pathogens," the authors said.
Jun 21 PLOS Negl Trop Dis study

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